Advertising Agency Liability
MEDIA/PRO® APPLICATION
IF A POLICY IS ISSUED ON A CLAIM EXPENSE WITHIN POLICY LIMIT BASIS, PAYMENT OF CLAIM EXPENSE SHALL REDUCE AND MAY EXHAUST THE LIMITS OF THE POLICY. THE COMPANY SHALL NOT BE LIABLE FOR CLAIM EXPENSE OR FOR THE AMOUNT OF ANY JUDGMENT OR SETTLEMENT TO THE EXTENT THAT SUCH EXCEEDS THE LIMIT OF INSURANCE OF THIS POLICY.
CLAIM EXPENSE SHALL BE APPLIED AGAINST THE SELF-INSURED RETENTION AND SHALL REDUCE, AND MAY EXHAUST, THE SELF-INSURED RETENTION.
Submission of a completed application incurs no obligation to purchase or bind insurance.
Note: All questions must be answered. All requested attachments must accompany application.
To complete this application, please submit:· Current audited financial statement, annual report and/or 10K
· Copies of standard contracts with clients and freelancers/independent contractors
· Experience résumés if in business less than three years
I. GENERAL INFORMATION
1. First Named Insured (including DBAs):
NOTE: First Named Insured is responsible for premium payment, cancellation and changes – refer to specimen policy.
Street Address:
City, State, Zip Code: Telephone Number:
Website Address(es):
2. Are there other Named Insureds and/or subsidiaries, affiliates, branch offices or other related entity(ies) (including DBAs) for which coverage is desired? Yes No
If yes, please provide a list of entities for which coverage is desired.
3. Do you participate in joint ventures? Yes No
If yes, list the name of each joint venture, describe your role and percentage (%) interest.
With respect to the joint venture(s) described above:
A. Do you require coverage for your participating interest only? Yes No
OR
B. Are you contractually required to provide coverage for the entire joint venture including all joint venturers? Yes No
All remaining questions on this application apply to all of the persons and entities described in Questions 1., 2., and 3. above, collectively referred to as “Applicant”.
4. A. Year applicant was established:
B. Location (city & state) of all applicant’s offices:
C. Geographic area(s) in which applicant’s advertising appears and advertising services are performed:
Local Statewide Regional National International
5. A. Is applicant wholly or partially owned by, affiliated with or controlled by any other entity(ies) not previously listed in
Question 1. or 2.? Yes No
B. Does applicant wholly or partially own, operate, manage or control any other businesses or entity(ies) not previously listed in Question 1. or 2.? Yes No
If 5.A. or 5.B. are answered yes, provide complete details:
6. Within the past five years has applicant:
A. Changed name? Yes No
B. Changed ownership structure? Yes No
C. Purchased or acquired another entity? Yes No
D. Merged or consolidated operations with another entity? Yes No
If any of 6.A. - 6.D. are answered yes, please attach a summary of relevant transactions.
7. List membership in any other industry groups or associations:
8. A. List major clients and description of their business:
B. Do any of applicant’s clients produce or manufacture:
Tobacco? Yes No
Firearms? Yes No
Alcoholic beverages? Yes No
Pharmaceuticals? Yes No
9. A. Is applicant a “full service” advertising agency? Yes No
If no, state area of specialization:
B. Does applicant obtain written releases with respect to creative material or talent from the following:
Employees? Yes No
Models? Yes No
Free-lance photographers, writers, composers, artists, musicians? Yes No
Non-professional persons appearing in commercials or advertisements? Yes No
C. Does applicant develop trademarks? Yes No
If yes, describe trademark search and clearance procedures:
Number of trademarks developed per year:
D. Does applicant’s contract always provide for client approval? Yes No
Attach a specimen copy of client contracts.
II. ACTIVITIES
10. Provide the approximate percentage of work performed in the following activities:
% / Billboards% / Crisis Management
% / Direct Mail
% / Events
% / Internet Advertising
% / Lobbying
Please describe:
% / Mail Order/Production of Catalogs
% / Market Research
% / Media Buying/Media Placement
% / Medical/Pharmaceutical Advertising
% / Mobile/Wireless Advertising
% / Package Design/Display Design/Product Design
% / Political Advertising
% / Printing (or assumption of liability for printing by others on your behalf)
% / Promotions, contests, games, sweepstakes
Please describe:
% / Public Relations
% / Print Material
% / Radio or Television Commercial Production
% / Search Engine Marketing/Optimization
% / Web Hosting
% / Website design/development (content only; “look and feel”)
% / Website design/development (infrastructure, including programming)
Please describe:
% / Other Advertising Activities
Please describe:
% / Other Consulting Activities related to Advertising, Marketing and Communications
Please describe:
III. CYBERLIABILITY – INTERNET AND TECHNOLOGY SERVICES THAT YOU PERFORM FOR OTHERS
11. Indicate the approximate percentages of revenue derived from the following Internet activities and services:
% / Internet marketing and data mining services% / Application Service Provider (ASP) services
% / Web page development, design and related consulting services
% / Website hosting and website administration services
% / Software development (Internet-related software)
% / Interactive electronic environments and virtual communities
% / Intranets, extranets and intra-business networks management and related consulting services
% / Search engine services
% / E-Commerce services (processing orders/facilitating purchases using credit/debit card or similar pay method)
% / Other Internet services – Describe:
12. Indicate the approximate percentages of revenue derived from the following Technology activities and services:
% / Electronic data processing services% / Custom software development services
% / IT systems analysis/design/integration/data migration and related consulting services
% / Software maintenance and support services
% / Hosting, co-location or managed network services
% / Support services and training for software and technology
% / Other technology services – Describe:
13. Describe your procedures for handling customer complaints or requests for corrections including the escalation process. Include those complaints and requests resulting from quality, performance, flaws or other anomalies in your activities and services.
14. Do you have a formal system development methodology? Yes No Not Applicable
If Yes, do you obtain your client’s written acceptance of systems or software prior to production or implementation? Yes No
15. Do you have procedures to safeguard against copyright infringement arising out of systems and/or software designed, developed or modified by you? Yes No Not Applicable
16. What percentage of your revenue is attributed to services provided by subcontractors and independent contractors? %
17. Describe your requirements for subcontractors, independent contractors and third party vendors to provide evidence of errors and omissions liability coverage.
18. Do you use written contracts or agreements related to the activities and services you provide? Yes No
If Yes, what percentage of the time are they used? %
19. Do your standard contracts contain the following provisions for your benefit?
A. Limitation of liabilities Yes No
B. Hold harmless or indemnity agreements Yes No
C. Disclaimer of warranties Yes No
20. Estimate the percentage of your client contracts which contain deviations from your standard provisions? %
21. Are all contracts and modifications approved by your legal counsel? Yes No
If No, describe the process for approval of contracts, deviations and modifications.
22. Do you enter into contracts where you accept liability for consequential damages? Yes No
If Yes, explain when and how often:
23. Briefly describe your three largest customer contracts:
CUSTOMer /SIZE OF CONTRACT
/ Duration /ServiceS
$$
$
IV. DATA AND PRIVACY PROTECTION
24. Does the Applicant employ security measures to prevent unauthorized access to the following:
A. The Applicant’s websites: Yes No
If Yes, please explain:
B. The Applicant’s premises and facilities: Yes No
If Yes, please explain:
C. The Applicant’s computer systems/servers in the custody of others: Yes No Not Applicable
If Yes, please explain:
D. The Applicant’s computer systems/services located on your premises: Yes No
If Yes, please explain:
E. The Applicant’s employee, vendor and customer data: Yes No
If Yes, please explain:
25. Describe the Applicant’s Anti-virus Software program.
26. Are security audits performed? Yes No
If Yes, please explain:
27. Does the Applicant have a formal documented security and/or privacy policy that has been read and is understood by all employees? Yes No
If No, please explain:
28. Does the Applicant have an employee assigned for maintaining network security? Yes No
29. Please indicate what types of electronic data records of third parties the Applicant stores on the Applicant’s computer system?
(Please check all that apply.)
Medical dataCustomer information
Credit card or bank account information
Trade secrets
Intellectual property assets
Other – Describe:
30. Does the Applicant transmit credit card, customer, employee, medical, monetary or financial information through wireless routers to banks for approval or to your central computer systems? Yes No
If No, does the Applicant utilize Wired Equivalent Privacy (WEP) security protocol? Yes No
If No to the above, please describe any additional measures that have been made to upgrade the Applicant’s WEP security protocol:
If the Applicant does not utilize WEP security protocol, does the Applicant utilize Wi-Fi Protected Access (WPA) or Wi-Fi Protected Access 2 (WPA2) security protocol? Yes No
31. Does the Applicant store personal, vendor or customer information on portable computers or mobile devices? Yes No
If Yes, does the Applicant have policies and procedures regarding their use and safekeeping? Yes No
If Yes, does the Applicant have policies and procedures regarding the tracking of these assets? Yes No
32. Does the Applicant transact business utilizing debit, credit, pre-paid, e-purse, ATM and/or POS cards? Yes No
If Yes, is the Applicant compliant with the Payment Card Industry Security Standards? Yes No
If Yes, is the Applicant compliant with the Fair and Accurate Credit Transactions Act (FACTA)? Yes No
33. Does the Applicant collect personally identifiable material regarding visitors to the Applicant’s websites? Yes No
If Yes, does the Applicant sell or otherwise distribute this material to third parties? Yes No
If Yes, does the Applicant disclose the privacy policy on your website(s)? Yes No
34. Does the Applicant perform regular computer system and data backups? Yes No
A. How often are backups performed?
B. Are backups stored off site? Yes No
V. RISK MANAGEMENT, CLEARANCE AND LEGAL PROCEDURES
Answer the following questions with consideration of media liability related issues, including but not limited to,
defamation, invasion of privacy, infringement of copyright or trademark, and errors & omissions.
35. Describe your procedures to ensure the accuracy and originality of matter/content created by you in-house:
36. Describe your procedures to check the accuracy and originality of matter/content created for you by independent contractors (such as freelance writers, photographers, artists):
37. Do you enter into contracts with independent contractors that provide matter/content to you? Yes No
If yes:
A. Does your contract contain an assignment of rights in the matter/content provided to you in any medium including digital and electronic format? Yes No
B. Do you require an indemnity in your favor with respect to claims arising from the matter/content provided to you by independent contractors? Yes No
38. Approximately what percentage of matter/content is:
A. Created by you in-house: %
B. Provided by independent contractors: %
C. Obtained from syndicates, stock photo houses, other (describe ): %
39. Do you accept unsolicited matter/content? Yes No
If yes, describe your procedure for processing and documenting the receipt of unsolicited matter/content:
40. Do you perform advertising campaigns in a language other than English? Yes No
If yes, describe:
41. Do you pay licensing fees to ASCAP, SESAC, BMI or other music licensing society? Yes No
42. Do you stream any content over your website(s)? Yes No
If yes, do you pay licensing fees to ASCAP, SESAC and BMI for the content that is streamed over your website(s)? Yes No
If no, give details.
43. Do you allow users to upload video, audio or any other third-party content to any website(s) you own or operate?
Yes No
If yes, please respond to the following questions:
A. Do you screen such uploaded content before it is posted on website(s)? Yes No
B. Do you have actual knowledge of content on your site that might infringe on any intellectual property or other rights of third parties? Yes No
C. Do you receive a financial benefit directly attributable to that user-uploaded video or audio content? Yes No
D. Do you have take down procedures in the event you are notified that user-uploaded video, audio or other third party content may infringe another’s intellectual property rights? Yes No
If yes, please attach the take down procedures your company has adopted for such notifications.
E. Have you implemented a termination policy for users of your website(s) who are repeat infringers? Yes No
F. Do you use filters or other software to screen your site for copyrighted user-uploaded video or audio content? Yes No
If yes, please explain:
44. Do you have a Risk Manager? Yes No
If yes, name of Risk Manager:
45. Do you have an in-house legal department? Yes No
If yes:
A. Name of General Counsel:
B. How many attorneys specialize in media liability related issues?
C. Describe your procedures for engaging in-house counsel with respect to media liability related issues including pre-publication/pre-broadcast review and post-publication/post-broadcast issues:
46. Do you utilize outside law firms with respect to media liability issues? Yes No
If yes, list name of law firms used:
47. Describe your procedures for utilizing outside law firms with respect to media liability related issues arising from the creation and development of advertising, media buying/placement and other services performed for clients:
VI. CLAIM EXPERIENCE
48. A. Have any claims, suits or proceedings been made during the past five years against the applicant or any of the applicant’s predecessors in business, subsidiaries or affiliates or against any of their past or present partners, owners, officers or employees? Yes No
If yes, provide complete details. Include type of claims, gist of offending matter, name of claimant, amount of defense costs, judgment or settlement, status or final disposition of the claim.
B. Is the applicant aware of any actual or alleged fact, circumstance, situation or error or omission arising out of the activities described in this application that may reasonably be expected to result in a claim being made against the applicant or any of the person or entities described in 63.A. above? Yes No